Mesothelioma Treatment

Quick Summary

The most common mesothelioma treatments are surgery, chemotherapy, and radiation. These traditional options play a key role in eliminating or reducing cancer cells. That said, some patients receive emerging treatments through clinical trials, which may give them a higher chance of survival. Veterans with mesothelioma can access top doctors and cutting-edge treatment through the VA.

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What Are My Mesothelioma Treatment Options?

Treatment options for mesothelioma vary based on the location of the cancer, the cell type of the cancer, and the patient’s general health. However, there is significant overlap in some of the more common treatment methods.

Standard treatment options for mesothelioma are:

  • Surgery
  • Chemotherapy
  • Radiation

All three treatment types can be used to extend lifespan or to reduce symptoms and improve quality of life. Your doctor will help you create the best treatment plan for your individual goals and needs.

Multimodal Treatment for Mesothelioma

Doctors often use a range of therapies simultaneously to help combat mesothelioma. Called multimodal treatment, this strategy works to eliminate as much cancer as possible by ensuring that mesothelioma cells left behind by one type of treatment are destroyed by another.

The most common type of multimodal treatment combines surgery with either radiation or chemotherapy.

The surgery removes the bulk of the cancerous tissue, while the chosen supplemental therapy is used to reduce the size of the tumor before surgery or to eliminate remaining cancer cells after surgery takes place.

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Pleural Mesothelioma Treatment

Pleural mesothelioma — the most common type — originates in the lining of the lungs (pleura). Its relative prevalence makes it the most well-researched form of mesothelioma, giving patients many options for treatment.

All three common types of treatment are used for the treatment of malignant pleural mesothelioma.

Surgery

Mesothelioma surgery is considered the best option for patients seeking curative treatment because it works to remove the cancer in its entirety. However, due to the demanding and invasive nature of most cancer surgeries, it may not be an option for everyone.

Surgery is most often considered for patients diagnosed in the early stages of mesothelioma when the cancer is still easily removable and hasn’t spread to distant areas of the body.

In later stages of the cancer, surgery may be considered too risky. Additionally, some patients may be excluded on the basis of age or poor overall health.

Extrapleural Pneumonectomy (EPP)

Extrapleural Pneumonectomy

The diagram above illustrates an EPP surgery. This surgery involves removing the affected lung and sometimes the pericardium and a piece of the diaphragm.

Extrapleural pneumonectomy (EPP) is an aggressive surgical treatment focused on removing as much cancerous tissue from the chest cavity as possible. Surgeons remove the affected lung, the lining of the lungs, the lining of the heart, and parts of the diaphragm.

Cancer patients must be in general good health to qualify for this surgery and may face quality of life issues after it is performed, like shortness of breath or dependence on an oxygen tank.

Pleurectomy/Decortication (P/D)

Pleurectomy With Decortication

During a P/D, doctors remove the lining of the affected lung as well as visible tumors. The lung itself is not removed.

Pleurectomy with decortication (P/D) involves selectively removing cancerous tissue from the lining of the heart, lining of the lung, and diaphragm. It is colloquially known as the lung-sparing surgery for mesothelioma, as the lung is left intact and is not removed.

Patients are not excluded from receiving this surgery on the basis of age. Many oncologists (cancer doctors) prefer it to EPP even for younger patients because it is less likely to negatively impact quality of life while giving those who undergo it similar benefits.

Chemotherapy

Chemotherapy is the most common form of treatment for pleural mesothelioma patients as there are no barriers regarding the age or general health of the patient. It may be given alone as part of a palliative treatment plan or as part of a multimodal plan to increase lifespan.

Pleural mesothelioma patients who undergo chemotherapy are usually given a combination of the drugs cisplatin and pemetrexed.

Radiation

During mesothelioma radiation, high energy particles and rays are aimed at tumors, destroying and damaging cancer cells so they cannot reproduce. This causes the tumors to shrink — making them easier to remove with surgery — and slows the spread of cancer.

Radiation therapy is considered non-invasive and is often a top choice for mesothelioma patients. It’s a popular option for palliative care because it can work to alleviate painful mesothelioma symptoms.

Palliative Care

Palliative treatment options for patients with pleural mesothelioma may be performed to remove a portion of the tumor or to decrease fluid build-up, both of which may cause chest pain and discomfort.

Common palliative options for pleural mesothelioma are:

  • Pleurodesis: Prevents fluid buildup in the pleura (pleural effusions)
  • PleurX™ catheter: Allows patients to drain pleural effusions from home
  • Thoracentesis: Removes excess fluid between the lungs and the pleura

Peritoneal Mesothelioma Treatment

Peritoneal mesothelioma originates in the lining of the abdomen (peritoneum). This type of mesothelioma accounts for 30% of all cases, making it the second most common form. As with pleural mesothelioma, common treatment options include surgery, radiation, and chemotherapy.

Surgery

If the patient has been diagnosed early and their general health is good, surgery is a popular and effective treatment option. As much cancerous tissue as possible is removed, slowing regrowth of the tumor and encouraging remission.

Cytoreduction With HIPEC

Cytoreduction with HIPEC, sometimes called the Sugarbaker Procedure, involves surgically removing the tumors in the abdomen (cytoreductive surgery) followed by a heated chemotherapy bath applied directly to the site of the surgery (hyperthermic intraperitoneal chemotherapy, or HIPEC).

The heated chemotherapy is meant to kill any cancer cells left behind, discouraging recurrence.

Additionally, the toxic side effects of chemotherapy drugs are reduced due to the heat. This reduced toxicity and the direct application of the chemotherapy to the abdominal cavity means that the dosage can be much higher than is viable with more traditional treatment.

Chemotherapy

Mesothelioma chemotherapy may be used to treat patients with peritoneal mesothelioma. The chemotherapy drugs are used to target and kill cancer cells within the abdomen. It can be used in conjunction with cytoreductive surgery, as mentioned above, or independently.

Palliative Care

One of the standard palliative treatment options for peritoneal mesothelioma patients is paracentesis. This procedure involves the removal of fluid buildup from the abdomen, helping decrease bloating and discomfort.

Other Mesothelioma Treatment Options

Different areas of the body require different treatment methods because the tissues and organs near the tumor vary widely depending on where it’s located. Pericardial mesothelioma — which originates in the lining of the heart — and testicular mesothelioma both require specific treatment.

Treatment of Rare Mesothelioma Types

A pericardiectomy is a surgical option for patients with pericardial mesothelioma. This procedure involves surgically removing the lining of the heart, called the pericardium.

Since pericardial mesothelioma is often diagnosed in its later stages, many patients with the cancer undergo the palliative treatment option pericardiocentesis, which empties excess fluid in the pericardium.

Testicular mesothelioma is often treated with an orchidectomy. This surgery removes one or both of the testicles, preventing the cancer from growing and spreading throughout the body. A partial orchiectomy may be performed in cases where only part of the testicle needs to be removed.

Alternative Mesothelioma Treatment

There are alternative treatments available for patients with mesothelioma. Although these methods may prove beneficial, they are not a substitute for medical care.

Alternative treatments for mesothelioma include:

  • Exercise
  • Herbal therapies
  • Meditation and breathing techniques
  • Well-balanced diet
  • Yoga

These lifestyle changes are often effective in increasing quality of life. They work to reduce stress and bolster general well-being, bringing positive mental and physical health benefits to many patients.

New Mesothelioma Treatment Options

There are new and emerging treatments becoming available for mesothelioma patients all the time. Many of these exciting new therapies are proving beneficial in treating this aggressive illness.

New mesothelioma treatment options include:

  • Photodynamic therapy: Patients receive a two-step regimen, consisting of a light-sensitive medicine and a light source, designed to kill cancer cells.
  • Gene therapy: Specific genes are injected into patients to inhibit cancerous cell growth.
  • Targeted therapy: Certain genes and proteins that are crucial for the reproduction of cancerous cells are targeted and destroyed, killing existing cells and preventing the formation of new ones.

Clinical trials are a great way to access these — and other — experimental treatments. The treatment methods used in clinical trials are still being researched, but they still represent an important tool in the fight against mesothelioma.

Patients who are interested in participating in a clinical trial should speak to their cancer care teams.

Mesothelioma Immunotherapy

Immunotherapy uses medications to stimulate the body’s immune system so it can fight cancer cells more effectively. Immunotherapy medications can increase the immune system response in several ways.

Some drugs, such as Yervoy® (generic name ipilimumab), enhance the body’s ability to make T-cells, which the body generates to fight diseases like cancer. Others, like Opdivo® (generic name nivolumab), help the body’s T-cells target cancer cells more effectively.

Did you know

In October 2020, the Food and Drug Administration (FDA) approved a combination of Opdivo and Yervoy for pleural patients. This marked the first mesothelioma treatment given clearance by the FDA in nearly 20 years.

How To Access Treatment for Mesothelioma Cancer

Determining where and how to access treatment can be difficult, as mesothelioma is a rare and aggressive cancer that is often initially misdiagnosed.

Working with a mesothelioma doctor at a specialized cancer center helps ensure an efficient diagnosis and expert care.

Mesothelioma Doctors

Veterans facing a mesothelioma diagnosis should know that the United States Department of Veterans Affairs (VA) works with some of the top mesothelioma specialists in the country. These doctors dedicate their time and experience to helping veterans from all over the country.

Top mesothelioma doctors who work with veterans include:

  • Dr. Avi Lebenthal

    A thoracic surgeon and director of Minimally Invasive Thoracic Surgery specializing in pleural mesothelioma. (Boston, MA)

  • Dr. Paul Sugarbaker

    One of the top peritoneal mesothelioma doctors in the country and a leading proponent of cytoreduction with HIPEC. (Washington, DC)

  • Dr. Robert Cameron

    A pleural mesothelioma surgeon who developed the lung-sparing P/D surgical procedure. (Los Angeles, CA)

Visit the UCLA Health website to learn more about Dr. Robert Cameron.

Disclaimer

The Mesothelioma Veterans Center has no affiliation with and is not endorsed or sponsored by Dr. Robert B. Cameron. The contact information above is listed for informational purposes only. You have the right to contact Dr. Cameron directly.

Mesothelioma Treatment Centers

There are also VA treatment centers around the country that specialize in mesothelioma. These centers have access to cutting-edge treatment options and state of the art equipment.

VA mesothelioma centers include:

Many VA medical centers help provide free, temporary accommodations for veterans and their loved ones while treatment is occurring. To access health care through the VA, or to receive other compensation and support, file for VA benefits.

Getting VA Benefits can be simple.

  • VA Disability Claims
  • Survivor Benefits
  • Finding Veteran Doctors

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Common Questions About Mesothelioma Treatment

Top Question

Can mesothelioma be cured?

While there is not yet a cure for mesothelioma, there have been cases of patients who have entered remission and survived well past their projected life expectancy.

Mesothelioma progresses differently in every patient. While average mesothelioma survival rates are statistically fairly low, aggressive treatment and a healthy lifestyle can help extend a patient’s lifespan.

Are there any new treatments for mesothelioma?

New and emerging treatments for mesothelioma are being tested and researched all the time.

The best way to access new treatment options is through clinical trials, which are implemented to find effective treatments for mesothelioma patients and to provide relief to those who haven’t had success with traditional treatment.

What is mesothelioma life expectancy without treatment?

The life expectancy of a mesothelioma patient without treatment is around 2-12 months. This is because mesothelioma is aggressive and can spread to distant areas of the body at a rapid rate.

How can I afford mesothelioma treatment?

The cost of mesothelioma treatment can be overwhelming for many patients and their families. Mesothelioma treatment centers work directly with a patient’s insurance company to ensure all medical claims are taken care of, reducing the stress of dealing with medical costs directly.

Patients without medical insurance still have options. Veterans and civilians with mesothelioma may be eligible for financial compensation to help pay for their medical care. Financial support programs can be accessed through the VA and other avenues, including asbestos trust funds and settlements.

Request a Free Mesothelioma Veterans Packet to learn more about your compensation options.

Veterans Support Team
Todd Gersten, MD PhotoReviewed by:Todd Gersten, MD

Double Board-Certified Oncologist and Hematologist

  • Fact-Checked
  • Editor

Todd Gersten, MD is a double board-certified medical oncologist and hematologist specializing in general adult oncology and hematologic disease. He is a physician partner with the Florida Cancer Specialists and practices in Wellington, Florida.

Dr. Todd Gersten is an independently paid medical reviewer.

Christopher Dryfoos PhotoWritten by:

Contributing Author

Christopher Dryfoos is a journalist and member of the American Medical Writers Association (AMWA). As the grandson of the U.S. Navy’s first forensic pathologist, he aims to help veterans with mesothelioma access needed care.

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